Department of Infection Prevention and Control, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania.
Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Infect Control Hosp Epidemiol. 2023 Sep;44(9):1485-1489. doi: 10.1017/ice.2022.319. Epub 2023 Jan 16.
To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes.
Observational, quality improvement study.
University medical center with a gastrointestinal endoscopy service performing ∼1,000 endoscopic retrograde cholangiopancreatography and ∼1,000 endoscopic ultrasound endoscope procedures annually.
Duodenoscope and linear echoendoscope sampling (from the elevator mechanism and instrument channel) was performed from June 2020 through September 2021. Operational changes during this period included standard reprocessing with high-level disinfection with ethylene oxide gas sterilization (HLD-ETO) was switched to double high-level disinfection (dHLD) (June 16, 2020-July 15, 2020), and duodenoscopes changed to disposable tip model (March 2021). The frequency of contamination for the co-primary outcomes were characterized by calculated risk ratios.
The overall pathogenic contamination rate was 4.72% (6 of 127). Compared to duodenoscopes, linear echoendoscopes had a contamination risk ratio of 3.64 (95% confidence interval [CI], 0.69-19.1). Reprocessing using HLD-ETO was associated with a contamination risk ratio of 0.29 (95% CI, 0.06-1.54). Linear echoendoscopes undergoing dHLD had the highest risk of contamination (2 of 18, 11.1%), and duodenoscopes undergoing HLD-ETO and the lowest risk of contamination (0 of 53, 0%). Duodenoscopes with a disposable tip had a 0% contamination rate (0 of 27).
We did not detect a significant reduction in endoscope contamination using HLD-ETO versus dHLD reprocessing. Linear echoendoscopes have a risk of contamination similar to that of duodenoscopes. Disposable tips may reduce the risk of duodenoscope contamination.
评估影响内镜逆行胰胆管造影和内镜超声内镜污染风险的变量。
观察性、质量改进研究。
大学医疗中心，胃肠内镜服务每年进行约 1000 例内镜逆行胰胆管造影和 1000 例内镜超声内镜检查。
从 2020 年 6 月至 2021 年 9 月进行十二指肠镜和线性超声内镜采样（来自提升机构和器械通道）。在此期间的操作变更包括标准再处理从使用环氧乙烷气体灭菌的高水平消毒（HLD-ETO）切换到双高水平消毒（dHLD）（2020 年 6 月 16 日至 7 月 15 日），并且十二指肠镜改为一次性尖端模型（2021 年 3 月）。通过计算风险比来描述主要结局的污染频率。
总的病原体污染率为 4.72%（6/127）。与十二指肠镜相比，线性超声内镜的污染风险比为 3.64（95%置信区间[CI]，0.69-19.1）。使用 HLD-ETO 进行再处理与污染风险比为 0.29（95%CI，0.06-1.54）相关。接受 dHLD 的线性超声内镜的污染风险最高（18 例中的 2 例，11.1%），而接受 HLD-ETO 的十二指肠镜的污染风险最低（53 例中的 0 例，0%）。具有一次性尖端的十二指肠镜的污染率为 0%（27 例中的 0 例）。
我们没有发现使用 HLD-ETO 与 dHLD 再处理相比，内镜污染显著减少。线性超声内镜的污染风险与十二指肠镜相似。一次性尖端可能会降低十二指肠镜污染的风险。
